Provider Demographics
NPI:1689701864
Name:CHIVIAN, NOAH - (DDS)
Entity Type:Individual
Prefix:DR
First Name:NOAH
Middle Name:-
Last Name:CHIVIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NORTHFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-4702
Mailing Address - Country:US
Mailing Address - Phone:973-731-4800
Mailing Address - Fax:973-731-1153
Practice Address - Street 1:100 NORTHFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-4702
Practice Address - Country:US
Practice Address - Phone:973-731-4800
Practice Address - Fax:973-731-1153
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ69011223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics